Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy
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Purpose: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil(SO) injection outcomes in proliferative diabetic retinopathy (PDR). Methods: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injectionwith >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinalattachment rate. Results: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR)and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio[AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independentlyassociated with a lower risk of final retinal attachment, and SO removal was associated with a higherincidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. Conclusions: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomyand SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline hada more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, orheavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsenthe prognosis.
Abstract
Purpose: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil(SO) injection outcomes in proliferative diabetic retinopathy (PDR). Methods: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injectionwith >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinalattachment rate. Results: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR)and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio[AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independentlyassociated with a lower risk of final retinal attachment, and SO removal was associated with a higherincidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. Conclusions: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomyand SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline hada more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, orheavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsenthe prognosis.
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